Question
I have a 16 yr. old son that is suffering and lacks mobility due to a slipped capital femoral epiphysis at age 12 that developed into avascular necrosis.  Nine major surgeries later, a hip replacement is the last hope.  How long can we expect this THR to last? We are worried about long-term implications! Any advice?

Answer
Hi Lisa

I had my first hip replacement at 16 also, due to avascular Necrosis.  If he's had nine surgeries and the hip replacement is the last hope, do it.  He will have to have revisions in the future.  Most first hip replacements last about 15 years.  Then each revision might last a bit longer and be a bit more intensive surgery because each time a hip is replaced, more bone is lost.

The hip replacements they use now are much better than the ones that I started with (I am 47 now, so my first surgery was about 30 years ago), and they only had cemented replacements.  Now they have replacements that are ceramic and that pop in and out for easier revisions.  They also have surgery techniques that are less invasive as well.

The long term implications are that he will always have to be careful of positions that his hip is in.  He will have precautions such as not rotating his knees inwards, not bending to over a 90 degree angle (if he sits, he cannot bend to put his chest on his knees), nor can he do contact sports.  But he will be able to lead an essentially normal life.  I was able to have two healthy children, a good marriage and college.  

He has to be careful to listen to exactly what his doctors recommend, especially in the beginning since dislocation is one thing he needs to avoid.  But his doctors will verse him well in what he can and cannot do physically.

He will be able to swim, bike ride, play golf and other low impact sports.  

I will tell you that this surgery was the best thing I ever did.  If I had not had the surgery, I would be looking at life in a wheelchair.

Be sure his surgeon has done a lot of these before you let anyone touch your son.  Find out if they can make a specialized implant specific to him.  If you can, call the Anderson Clinic in Alexandria VA.  There is a Dr. Charles Engh there who is a "god" and did my surgery.  They had to make a specific implant for me since I needed a longer implant than most.  I don't have the telephone number but look up Charles Engh at the Anderson Clinic with Inova Medical center.  Also, one other important thing to ask is to find out of they can insert a larger cup for the ball part to go into because he is young and more active.  The larger the cup part is, the less likely he will have a dislocation problem.

Please let me know how things go.  The recuperation will be hard, but he will be so happy with the results.

Sharon Davis